Exoskeleton-assisted rehabilitation training improves cognitive and motor functions in multiple sclerosis patients

Abstract

The objective of this chapter is to evaluate the use of the same exoskeleton, the ‘Human Body Posturizer’, to assist rehabilitation processes in multiple sclerosis patients during a six-week intervention using a pilot randomized controlled trial. Background: As previously found, a single exoskeleton application did improve mobility in multiple sclerosis (MS) patients, with effects also at brain level. Objective: To evaluate the use of the same exoskeleton, the ‘Human Body Posturizer’ (HBP), to assist rehabilitation processes in MS patients during a 6-week intervention using a pilot randomized controlled trial. Methods: Twelve patients were evaluated using multiple neurological, motor, functional and cognitive testing before and after 6-week multidisciplinary rehabilitation training performed wearing normal clothes (control group) or wearing the HBP (experimental group). Participants were randomly assigned to control or experimental group. Event-related potentials were recorded to measure temporal brain dynamics during cognitive testing. Results: Both groups improved performance as shown by neurologic, motor and functional testing, but only the experimental group showed positive treatment effects in cognitive tasks, disability status and fatigue severity. In cognitive tasks, the experimental group showed significant benefits in terms of processing speed and response accuracy, and, at brain level, they showed enhancement in proactive preparatory activity in frontal and prefrontal cortices, and stronger post-stimulus reactive activity in the anterior insula related to a more efficient stimulus-response decision making. No effects were reported for visual information processing. Conclusion: Both rehabilitation protocols are supported by objective neurophysiological and mobility improvements, but the HBP intervention was more effective especially reducing disability status and fatigue, likely stimulating cognitive processing in prefrontal cortex.